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Chronic obstructive pulmonary disease: a community-oriented program including professional education and screening by a voluntary health agency.

A community program for chronic obstructive pulmonary disease that included detection by screening, professional education, community involvement, and evaluation of results is described. Key figures in the success of this program were senior medical students. In the first community, in which no professional education was offered, 45.3% of persons screened who had abnormal test results came away from their physicians understanding that they did not have a significant health problem. In subsequent communities, in which professional education was a part of the program, this percentage decreased steadily to approximately 11%. Consistently, 25% of the persons screened who had abnormal results did not consult a physician. Twenty-one % of the participants with abnormal results of screening and no previous knowledge of pulmonary disease stopped smoking in the ensuing 2 to 3 yr, whereas only 11.7% of the control group of persons with normal screening results did so.

Adult↗

An oocyte donation program with goserelin down-regulation of voluntary donors.

BACKGROUND: In ovum donation programs oocytes can be requested from infertile women going through an in vitro fertilization cycle. Currently, when embryos can be cryopreserved, these donors have virtually disappeared. Instead, most donors have been healthy fertile volunteers willing to go through an IVF attempt solely for the purpose of donating all oocytes. METHODS: Sixty-four patients had 93 started cycles of oocyte donation from 59 donors. Twenty recipients had primary ovarian failure, 24 had secondary ovarian failure, 15 had had repeated failures in earlier IVF attempts and five were carriers of genetic diseases. The donors were 51 healthy volunteers recruited through the press. Eight patients from an IVF program donated excess oocytes. Donors were not paid and their mean age was 30 years. To minimize discomfort of the treatment, a long-acting GnRH-agonist, goserelin, was used for down-regulation. RESULTS: The pregnancy rate per transfer with fresh embryos was 28.4% (23/81) and with frozen-thawed embryos, 17% (3/18). Twenty-one healthy infants have been born including one set of triplets and three sets of twins. Nine pregnancies ended in abortion and one in intrauterine fetal death. The most common complications of pregnancy were pre-eclampsia and pregnancy-induced hypertension (41.2%, 7/17). Ten of 17 patients delivered by cesarean section (58.8%). CONCLUSION: It was possible, through the press, to obtain highly motivated oocyte donors, who go through IVF treatment solely for altruistic reasons. Oocyte recipients appear to have many complications in their pregnancies. Until more data are available, these patients need a high standard of obstetric care.

Adult↗

How voluntary prenatal diagnosis and selective abortion increase the abnormal human gene pool.

It is often assumed that prenatal diagnosis followed by the selective abortion of "defective" fetuses has a positive eugenic effect. Although mandatory selective abortion of "defective" fetuses and, more important, carriers would tend to reduce the number of deleterious genes in the gene pool, the present program of voluntary prenatal diagnosis and selective abortion actually increases the number of deleterious genes. This raises the issue of freedom of choice regarding selective abortion and societal pressure on parents to undergo prenatal testing and to abort their fetus should it have a genetic disorder or be a carrier of one.

Abortion, Therapeutic↗

The ethics of health education as public health policy.

The concept of voluntariness is central to an understanding of ethical considerations in two aspects of public health education practice: (1) the selection of appropriate interventions, and (2) the selection of appropriate targets for such interventions. The position is taken that most mass communications programs in public health education are persuasive as well as informative in intent. It is argued that the impact of such programs on voluntariness can be analyzed with regard to the rationality and resistibility of the persuasive appeals involved. Considerations of justice, as well as voluntariness and liberty, are reviewed in the discussion of appropriate targets for intervention. The issue of victim-blaming in public health education is explored, and conditions under which behavioral public health programs may be morally justifiable are suggested.

Choice Behavior↗

LIFECHECK: a successful, low touch, low tech, in-plant, cardiovascular disease risk identification and modification program.

LIFECHECK, a voluntary, in-plant cardiovascular risk identification and modification program, was developed to complement Coors Wellness Center-based programs. LIFECHECK was offered to the 1,320 employees located at the Coors Engineering Center and Can Manufacturing Complex at the Coors Brewing Company. The initial 30-minute screening included height, weight, blood pressure, cholesterol, smoking history, weekly Kcal expenditure, self-rating of health, and health effects of stress. Participants concluded the screening session with a wellness counselor who reviewed results and referred them to the appropriate intervention activities. The eight-week intervention was provided at the worksite and was available to all shifts. The intervention included an activity competition and activity classes; nutrition, hypertension, smoking, and lipid classes; a smoke-out day; one-on-one counseling; exercise equipment at four worksites; posters; traymats; table tents; and electronic messages. A total of 692 employees, 52% of those eligible, participated in the initial screening. Of these, 91% had one or more risk factors, and 33% had three to five cardiovascular disease risk factors. A total of 499 employees, 72% of those eligible, completed the follow-up screening. Thirty-two percent of the employees who participated in LIFECHECK had not used the Wellness Center in the eight years it had been open. There were significant changes in employees who completed the eight-week program for systolic blood pressure, total cholesterol, weight, physical activity, and risk of ischemic heart disease within eight years as measured by the Framingham score (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

HIV antibody screening. An ethical framework for evaluating proposed programs.

We believe that the greatest hope for stopping the spread of HIV infection lies in the voluntary cooperation of those at higher risk--their willingness to undergo testing and to alter their personal behavior and goals in the interests of the community. But we can expect this voluntary cooperation--in some cases, sacrifice--only if the legitimate interests of these groups and individuals in being protected from discrimination are heeded by legislators, professionals, and the public. Yet voluntary testing is not enough. We must proceed with vigorous research and educational efforts to eliminate both the scourge of AIDS and the social havoc that has accompanied it.

Acquired Immunodeficiency Syndrome↗

Ethics, epidemiology, and women's health.

Ethical issues arise throughout the conduct of epidemiologic studies, in the processes of determining the study question, designing the protocol, and implementing the study. There also is an ethical dimension when studies are not done, for example, in studies of the effect of drugs and chemicals on male reproductive capacity. Harm as well as risk must be considered in the conduct of epidemiologic studies. The ethical principles that govern research, while independently justifiable, may come into conflict. Principles that govern research also may conflict with those that predominate in clinical practice. An example is the current controversy over unblinding anonymous, newborn human immunodeficiency virus seroprevalence studies to identify potentially infected infants. As women's health becomes more prominent on the research agenda, the resolution of these conflicts will become a complex challenge to epidemiologists, ethicists, clinicians, and the communities they serve.

AIDS Serodiagnosis↗

Two methods for examining angular response of personnel dosimeters.

The American National Standard ANSI N13.11-1983 is used to test the accuracy (bias plus precision) of dosimetry processors as part of the dosimetry accreditation program of the National Voluntary Laboratory Accreditation Program (NVLAP). Section 3.8 of the ANSI N13.11-1983 standard requires that a study of the angular response of a dosimeter be carried out once, although no pass/fail criterion is given for angular response. The NVLAP accreditation program excluded Section 3.8, and thus no angular response data have been generated in an organized fashion. The objective of this project is to examine the feasibility of two alternative methods to test the angular response of personnel dosimeters. The first alternative involves static irradiations with the dosimeters at fixed angles to a radiation source. The second alternative involves dynamic irradiations with the dosimeters mounted on a rotating phantom. A Panasonic UD-802 personnel dosimetry system** was used to generate data to examine both alternatives. The results lead to two major conclusions. Firstly, Section 3.8 of the ANSI N13.11-1983 standard should be amended to require a pass/fail test for angular response. Secondly, a comparison between angular response data generated with a fixed or a rotating phantom shows that the rotating phantom is the more cost-effective method.

Algorithms↗

Legal rights and duties in the AIDS epidemic.

This article provides an overview of some major areas of legal concern in which the AIDS epidemic is having an impact. The rights of infected individuals to testing, treatment, and confidentiality are reviewed, and emphasis is given to their claims to nondiscrimination regarding access to health care, employment, housing, education, insurance, and related interests. Infected persons' duties to contain transmission of AIDS are outlined under principles of criminal and civil law, including liability for provision of contaminated blood products. Uninfected people's general rights to protection are considered, and health professionals' and authorities' rights and duties are given more detailed attention. In conclusion, some legal developments outside the United States are reviewed.

Acquired Immunodeficiency Syndrome↗